Intraocular surgery in kyphosis

Kyphosis is a progressive, curvature of thoracic spine which results in rounding or bowing of the back. Curved spine accompanied by restricted neck motion and poor lung reserve present challenges for an ophthalmic surgeon who is used to patient's neck and head resting flat on the operating table and the eye in the horizontal position. Intraoperative difficulties include poor view, inability to maneuver surgical instruments properly and constant threat of elevated vitreous pressure. Several innovative solutions have been published including, maximal reverse Trendelenburg position with pillows under the head and neck, use of a donut and wedge shaped head positioner, allowing the patient to remainin upright sitting position while their head is positioned horizontally in a modified waiting room chair, performing surgery while standing, using 4- section orthopedic operating table, laying the patients on their sides, side saddle positioning, face-to-face positioning, parachute type harness inferior corneal retraction suture, or extreme patient positioning for retinal surgery. This chapter highlights various surgical options to facilitate surgeons pick the best course of action when dealing with intraocular surgery in patients with kyphosis.